Ray Brovont is a former Army doctor who worked as the medical director of an emergency room. For years, he regularly pleaded with his employers to hire additional staff, but the company refused. Now he’s out of a job and claims he was fired for speaking out.
Brovont says for-profit healthcare facilities are driving ER systems to the breaking point, which can put patients and providers at risk. His story speaks to the growing trend of private equity firms buying healthcare companies and then selling them for a profit.
Targeted for Speaking Out
During his time as an Army doctor in Iraq, Brovont was focused on identifying potential problems before they turned into a full-blown crisis. He applied that same methodology when he took over as the director of the ER at Overland Park Regional Medical Center in Kansas near Kansas City, Missouri in 2012.
“The goal was to identify an issue before there was a bad outcome,” he said.
One of the problems he discovered was that the hospital’s “code blue” system had become unsafe for patients. These calls are made when a patient’s heart stops, or they are no longer breathing. ER doctors are required to attend to code blues, which usually means stopping whatever they are doing and rushing to the ER.
Brovont and his fellow ER doctors found themselves short staffed after the hospital doubled its capacity to 343 beds. “My physicians were being asked to be in three places at once,” Brovont said.
Staffing at the hospital was overseen by EmCare, a healthcare staffing company. The private equity firm Clayton, Dubilier & Rice owned the company until 2015 when the firm issued stock to the public. However, records show executives from Clayton, Dubilier & Rice stayed on the board of EmCare until 2017. KKR, another private equity firm, later bought the staffing company in 2018 and changed its name to Envision Healthcare.
Brovont first spoke out about the problem back in 2012, but he didn’t get a response. He shared his concerns with Dr. Patrick McHugh, his superior at EmCare. Brovont told McHugh that federal law requires trauma centers like Overland Park to make a physician available 24/7 in the emergency department to examine incoming patients and that the facility was in danger of failing to comply.
Brovont said hiring another ER doctor would solve the problem, but McHugh told him and the other physicians that the facility wouldn’t be hiring another doctor because “profits are in everyone’s best interest,” according to an email he sent to staff members.
The former Army doctor later sent a memo to management urging them to hire more staff in 2017 and was fired six weeks later. He then filed a lawsuit against EmCare for wrongful termination. The jury awarded him $29 million, including $20 million in punitive damages, which was reduced to $26 million on appeal. That ruling was final.
According to documents from the suit, the company was more interested in profits than improving care. “There is a responsibility as the corporate representative to support the corporation’s objectives,” McHugh told Brovont, according to court filings.
Brovont was also barred from working at other nearby hospitals owned by EmCare. Because he was an independent contractor and not a regular employee, he couldn’t argue his case in front of a tribunal.
In response to the lawsuit, Envision Healthcare said it complies “with state laws and operates with high ethical standards that put patients’ health and safety first.”
“Envision clinicians, like all clinicians, exercise their independent judgment to provide quality, compassionate, clinically appropriate care based on their patients’ unique needs,” it said in a statement. “The concern raised by Dr. Brovont was related to a hospital policy, not an Envision policy, and predates Envision’s current leadership team.”
A Growing Problem
Brovont’s story isn’t unique.
Research shows that over 40% of the country’s hospital emergency departments are overseen by for-profit healthcare staffing companies owned by private equity firms, including Envision Healthcare, which is owned by KKR, and TeamHealth, of the Blackstone Group.
These firms typically use large amounts of debt to buy healthcare companies. They will then try to increase profits quickly before turning around and selling the company for a profit. This usually means increasing capacity without hiring additional staff.
“The money in the hospital is in the ER,” said Richard M. Scheffler, a professor of health economics and public policy at the University of California, Berkeley. “It is the biggest net generator and a huge profit center for almost all hospitals.” The problem is that “ER doctors are being told how to practice medicine” by financial managers.
“These administrators who make these changes and implement these policies don’t feel the downstream effects of their policy changes,” he said. “They look at the outcome, and the outcome is ‘Hey, we’re making money.’”
Thirty-three states have laws that prohibit corporations from intervening in medical care, but experts say private equity firms can get around these laws by making a physician the owner of the subsidiaries.
For example, Dr. Gregory J. Byrne, an emergency medicine practitioner in Southlake, Texas, has been the owner of 300 healthcare facilities affiliated with Envision Health. He was hired by the firm to be the physician running the emergency department that Brovont directed at Overland Park.
But Brovont says he had never heard of Byrne until he filed his wrongful termination lawsuit in 2017. He says Byrne wasn’t running the ER, Dr. Patrick McHugh, the executive from Envision, was. According to testimony in the case, Byrne played no role in the department’s oversight, court documents show.
“The exact number of EmCare subsidiaries [Byrne] owns changes every month,” the court ruled, “and he does not keep track of them or take any management role in any of them. The number does not matter to him because all the profits of the subsidiaries flow to EmCare.”
Brovont now practices emergency medicine at a hospital near Overland Park and runs a clinic where he provides alternative treatment options for patients with depression and post-traumatic stress disorder.